Basic Information
| Provider Information | |||||||||
| NPI: | 1447582416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REISER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | M.S. / LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1421 DOWNEY ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820721867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073993387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1465 N 4TH ST | ||||||||
| Address2: | SUITE 119 | ||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820722066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077210700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 02/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-1081 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.